Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group

Sperr, Wolfgang R.; Wimazal, Friedrich; Kundi, Michael; Baumgartner, Christian; Nösslinger, Thomas; Makrai, A.; Stauder, Reinhard; Krieger, O.; Pfeilstöcker, Michael; Valent, Peter

doi:10.1093/annonc/mdp258

Cited by 107 publications

(75 citation statements)

References 29 publications

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“…We propose to use the MDS-CI for assessment of comorbidities in the future since it has shown its high stability in haematologica 2014; 99:e31 © F e r r a t a S t o r t i F o u n d a t i o n the hands of different study groups and has the most consistent results, 3,11 in contrast to the inconsistent results produced when using CCI and HCTCI to assess comborbidities for all MDS patients. 7,9,11,12 Furthermore, the MDS-CI is independent of the IPSS-R, as shown in our present study, and is independent of the WPSS, as shown by Breccia 8 and Della Porta 3 and co-workers. Comorbidities can be an important factor in clinical decision making.…”

supporting

confidence: 86%

The myelodysplastic syndrome-comorbidity index provides additional prognostic information on patients stratified according to the revised international prognostic scoring system

et al. 2014

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supporting

confidence: 86%

The myelodysplastic syndrome-comorbidity index provides additional prognostic information on patients stratified according to the revised international prognostic scoring system

et al. 2014

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“…17 Performance status and comorbidity were assessed by ECOG performance scale 18 and the hematopoietic SCT specific comorbidity index (HCT-CI), respectively. 19,20 Acute GVHD and chronic GVHD were assessed by the National Institutes of Health (NIH) Consensus Criteria. 21 …”

Section: Definitionsmentioning

confidence: 99%

Survival benefits with transplantation in secondary AML evolving from myelodysplastic syndrome with hypomethylating treatment failure

et al. 2012

Bone Marrow Transplant

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The prognosis for patients with myelodysplastic syndrome with hypomethylating treatment failure (MDS-HTF) has been known to be poor. However, the clinical outcomes and optimal treatment options for secondary AML evolving from MDS-HTF (sAML/MDS-HTF) are not well known. This retrospective analysis was conducted to evaluate the clinical outcomes and influences of treatment options on survival in 46 consecutive patients with sAML/MDS-HTF. The median OS rates were 1.4 months in the best supportive care group (n ¼ 15) and 9.4 months in the active treatment group (n ¼ 31). One-year OS rates were 13.3% and 36.8%, respectively (P ¼ 0.001). Active treatment (Po0.001), lower BM blast (o33%) at sAML (P ¼ 0.007), non-poor NCCN (National Cancer Comprehensive Network) cytogenetics (P ¼ 0.001) and good performance status (ECOG (Eastern Cooperative Oncology Group) p1) (P ¼ 0.024) were significant predictors affecting favorable OS in a multivariate analysis. Of the active treatment options, allo-SCT with prior chemotherapy (CTx) showed better OS compared with CTx only or SCT without CTx (P ¼ 0.019). Our analyses suggest that active treatment, particularly SCT following CTx, should be considered in patients with sAML/MDS-HTF if the patient is medically fit.

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“…45,47,52,58,62,[77][78][79][80][81][82][83][84] At least five other studies reported on the ability of the HCT-CI to provide good prediction of conventional treatment outcomes among patients with AML or MDS, which adds another layer to the generalizability of this index. [85][86][87][88] One study found the HCT-CI to be a sole independent predictor of outcomes among patients receiving relative or cord blood grafts, but of less strength in smaller samples of subgroup analyses. 89 Only four studies disagreed with the validity of the HCT-CI for outcome prediction.…”

Section: Validity and Reliability Of The Hct-ctmentioning

confidence: 99%

Comorbidities and Hematopoietic Cell Transplantation Outcomes

Sorror

2010

Hematology

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Conventional allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for various hematological diseases due, in part to high-dose conditioning and, in part, to graft-versus-tumor effects. Reduced-intensity or non-myeloablative conditioning regimens have relied mostly on graft-versus-tumor effects for disease control, and their advent has allowed relatively older and medically infirm patients to be offered allo-HCT. However, both HCT modalities have been associated with organ toxicities and graft-versus-host disease, resulting in substantial non-relapse mortality. It has become increasingly important to optimize pre-transplant risk assessment in order to improve HCT decision making and clinical trial assignments. Single-organ comorbidity involving liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. Recent efforts have resulted in the advent of a weighted scoring system that could sensitively capture multiple-organ comorbidities prior to HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality than other non-HCT-specific indices. Subsequent studies, with the exception of a few studies with modest numbers of patients, have confirmed the prognostic importance of the HCT-CI. Further, the HCT-CI has been consolidated with various disease-specific and patient-specific risk factors to refine assignments of patients to the appropriate HCT setting. Ongoing studies are addressing prospective validation of the HCT-CI, furthering our understanding of biological aging, and enhancing the applicability of the HCT-CI comorbidity coding. Future knowledge of the impacts of multiple comorbidities on post-HCT toxicities might guide new prophylactic and therapeutic interventions to lessen the procedure's mortality.

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Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group

Abstract: Together, our data show that comorbidity is an important risk factor for OS and EFS in patients with MDS.

Cited by 107 publications

References 29 publications

The myelodysplastic syndrome-comorbidity index provides additional prognostic information on patients stratified according to the revised international prognostic scoring system

The myelodysplastic syndrome-comorbidity index provides additional prognostic information on patients stratified according to the revised international prognostic scoring system

Survival benefits with transplantation in secondary AML evolving from myelodysplastic syndrome with hypomethylating treatment failure

Comorbidities and Hematopoietic Cell Transplantation Outcomes

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